Parlez-vous Health Level 7?

By Bob Brewin
01:00 AM

At first glance, Canada?s development of an electronic health record system to serve the 80,000 members of the Canadian Forces might not seem like a big deal compared to the U.S. Defense Department?s EHR system, which is intended to serve more than 9 million beneficiaries.

But Maj. Paul Chittick, functional analyst for the Canadian project, pointed out that although the DOD system dwarfs Canada?s in scale, the latter project does something no other military health system in the world does: It automatically translates information from English to French and vice versa ? an essential ingredient for any system in the bilingual country.

Dr. Gary Saunders, a physician at the military?s base in Esquimalt, British Columbia, helped develop the Canadian Forces Health Information System (CFHIS). ?It?s just amazing,? he said. ?Hit a button, and the screen changes from French to English or English to French.?

Lockheed Martin Canada ? the integrator for the five-year, $56 million contract ? tapped Purkinje of Montreal to develop the bilingual patient scheduler and clinical notes software. Purkinje will provide an EHR system based on structured and coded data, so clinicians will have ?a modular tool [that] is flexible, bilingual [and] can be customized,? said Dan Spoor, president and chief executive officer of Lockheed Martin Canada.

Lucian Jeglinschi, general manager of Purkinje?s Canadian operations, said his company has been working on bilingual software since the early 1990s and has deployed its systems throughout Canada and Europe. Purkinje?s EHR software derives its intelligence from a database of more than 300,000 medical terms that can be expressed in French or English, and the company continually updates the database.

Users access the terms through templates designed to serve a wide variety of clinical needs and specialties. Clinicians can also modify the templates to fit their particular needs or method of working, Jeglinschi said.

Saunders emphasized that CFHIS? bilingual functions only work within the templates. SCC Soft Computer of Palm Harbor, Fla., is providing the bilingual laboratory and radiology software for CFHIS, Chittick said.

Although Canada?s military is small, it deploys often and works closely with NATO forces, including the United States. Chittick said he considers interoperability with NATO and DOD systems a core function of CFHIS. DOD plans to give a Canadian task force in Afghanistan access to its Joint Patient Tracking Application.

To ensure compatibility with other nations? systems, Chittick said he is pushing the use of standards in CFHIS, including Health Level 7 data interchange and messaging standards. Like DOD, the Canadian military views an EHR system as an opportunity to collect patient information servicewide and use data-mining techniques to help manage chronic health problems, Saunders said.

?Gated? contracting
For CFHIS, the Canadian Forces took a unique contracting approach that contrasts with similar integration deals in the United States. The Canadian military tapped Lockheed Martin Canada to be the integrator for CFHIS in February 2003 but divided the contract into phases and required the company to bid on each phase. Chittick said the ?gated? approach allowed the military to assess the company?s performance at each phase of the project.

Lockheed Martin Canada completed CFHIS? first phase ? developing a master patient index and scheduling capabilities ? in November 2004. That $14.6 million contract also called for a proof-of-concept demonstration of the entire CFHIS system at bases in Edmonton and Ottawa.

Saunders tested the electronic scheduling tool at his two-person clinic. ?It worked very well, much better than a [manual] patient scheduler,? he said.

The company met all of phase one?s mandatory requirements and stayed within budget, Chittick said.

In January 2005, the Canadian Forces awarded the company a $26.6 million contract for the second phase of CFHIS. Under that contract, which is expected to run through June 2007, Lockheed Martin Canada must deploy a limited-capability version of the system at all 80 of the military?s medical and dental clinics, which are staffed by 2,500 health professionals. That phase will also include a pilot test of the system?s full-capability version, which includes laboratory, radiology, dental and pharmacy modules, followed by a full deployment of initial components to all clinics.

The second phase also calls for the company to develop the final version of the system with a clinical notes module. Deployment of that module and the order-entry software is planned for the third phase, which is scheduled to run from September 2007 through August 2009, Chittick said.

Saunders said he has no doubts that when the CFHIS project is completed in 2009 it will dramatically improve health care for the Canadian military in not one but two languages.